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Sepsis-induced ARDS has been widely investigated and better results have been obtained using higher or multiple doses of surfactant.
In sepsis-induced ARDS, using 50 mg/kg of natural surfactant, initial improvement is variable but at 12 hours the beneficial effects are more homogeneous and stable. In several cases a supplementary dose at 24 hours is necessary to stabilise the improvement obtained. Severity of lung injury, time of surfactant application and mode of ventilation (small tidal volume, high respiratory rate and high PEEP levels are recommended) play an important role in the efficacy of surfactant supplementation. From Marraro et al 1999.
Marraro G. Minerva Anestesiol 1999